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    Infusion code for Actemra

    I am trying to find the correct CPT infusion code for Actemra infusions. Everywhere I looked on the internet just said to use 96365 or 96413. Does anyone have any experience billing this drug and it's infusion? I do not code based on payer guidelines or the type of insurance a patient has...
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    B-12 Injection Conundrum

    Hi! I bill these injections a lot for the Oncology practice I code for and they are normally paid for by insurance if they are medically necessary. What dx code are you using? If the patient actually has a deficiency, you can use 266.2 or 281.1. I would first look on the commercial insurance...
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    Therapeutic Infusion Pump???

    I came across the following information in a CPT Assistant Article: "The provider is cautioned not to assume that the 96000 series of CPT codes would be appropriately reported for every biologic response modifier, chemotherapeutic drug, or monoclonal antibody agent. For example, the CPT...
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    Concurrent vs. Sequential IV Infusion

    Thanks for your reply, I keep coming across this same scenario with an infusion of magnesium. It is reported completely separate from the saline infusion so it's not hydration and the magnesium runs for about an hour prior to and then the entire time the chemotherapy runs. I can't find any...
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    Help with magnesium infusions

    I was wondering if anyone can help me code the following scenario. I am having a hard time deciding whether or not to bill for all 4 hours that the magnesium was administered or if I should just report the hour that it ran prior to the chemo infusion. Here is how the start and stop times are...
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    JW Modifier

    The JW modifier is not always required when billing for waste, it is a carrier preference. If you are going to bill using the JW modifier, you would report the amount of drug that was given to the patient (J-Code and correct units) on one line of the claim and then on another line, you would...
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    Therapeutic Infusion Pump???

    Does anyone have experience coding for a therapeutic drug (Mesna) that is administered in a continuous infusion pump overnight? If the Mesna were mixed with Ifex, I would use the code for the chemo pump initiation, 96416, however, the Ifex is only being administered in the chemo suite/office...
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    5-FU and Portable Pump Billing

    Do you know what you would code if the drug being infused in the pump is a therapeutic drug like Mesna?
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    CHONC Certification

    When coding waste on the exam, do they want you to use the JW modifier or just bill for the entire vial on 1 line?
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    Aloxi Administration

    What substance or drug is in the "running IV?" If it is saline then yes, Aloxi can be reported as an IV push or 96374. If the drug running in the IV is chemotherapy, I would code the push of Aloxi as 96375 but it all depends on what is in that "running IV." Please clarify for a more in depth...
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    Concurrent vs. Sequential IV Infusion

    I am "stuck" on a chemotherapy infusion encounter and wondered if anyone else has come across something like this: Mannitol - IV Infusion from 10:00 - 15:30 Decadron - IV Push at 11:00 Kytril - IV Push at 11:02 Pepcid - IV Push at 10:25 Cisplatin - chemo iv infusion from 11:40 - 13:10...
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    oncology billing concern

    Debra is correct, there is no way to answer this without knowing what the denial says, what diagnosis code you are using and the CPT codes you are using. Is it being billed with any other drugs or infusions? Are you using V58.12 as the 1st diagnosis code? How many units was the patient given...
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    To bill a Pyloroplasty or not to bill.....

    Can anyone tell me, if a pyloroplasty is done in conjunction with a partial esophagectomy and we bill CPT code 43117, should the pyloroplasty be reported separately? The description of CPT code 43117 states, "partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal...
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    94150 -Peak flow question - Help!!

    I was wondering if a patient can have 2 peak flow studies done on the same day and if so, can it be billed twice or in units of 2? I can't seem to find anything that states whether or not it should be billed more than once/day. Does anyone have any documentation to support billing it once or...
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    94150 - Peak flow question - Help!

    I was wondering if a patient can have 2 peak flow studies done on the same day and if so, can it be billed twice or in units of 2? I can't seem to find anything that states whether or not it should be billed more than once/day. :confused: Thanks for your help!!
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    Denial by secondary insurance - HELP!!

    The doc is the one who coded it. Unfortunately, it didn't come to me until after it was denied by the secondary insurance. I know that psych rehab is not an acute inpatient POS and I wouldn't have coded it that way. What I'm asking is now that it is being denied, does anyone have any...
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    Denial by secondary insurance - HELP!!

    The crosswalk is something that we've used since Medicare quit accepting consult codes. If a physician does a consult and the patient has Medicare, based on the key components of an E/M, we crosswalk their consult level of service to an initial inpatient code. I agree that maybe Medicare...
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    Denial by secondary insurance - HELP!!

    Hello. I have a situation where one of our psych docs saw a patient at a Comprehensive Inpatient Rehabilitation facility (POS 61). The patient was elderly and had Medicare as primary insurance so our physician billed a 99223 instead of a consult code which is perfectly acceptable for Medicare...
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    POS 61 and Psych Consults & Cigna

    Hello. I have a situation where one of our psych docs saw a patient at a Comprehensive Inpatient Rehabilitation facility (POS 61). The patient was elderly and had Medicare as primary insurance so our physician billed a 99223 instead of a consult code which is perfectly acceptable for Medicare...
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    Infusion Pump Billing

    The correct way to bill for a pump d/c is 99211 - there is no CPT code for the pump d/c so you bill 99211 with V58.81 as the diagnosis code. V58.82 might be an appropriate dx code as well.
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    HELP! Pacer and ICD Denials

    Very helpful, thank you!!
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    HELP! Pacer and ICD Denials

    What if the patient has had a history of cardiac arrest or had a CABG within the last year? I have one claim for a person who had a CABG and 9 days later needed an ICD implanted.....this is so confusing! What do they mean by "primary prevention?"
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    44140 vs. 44160 HELP please!!!

    I have an op report that I am having a difficult time dissecting. I wondered if anyone would be able to give me some direction. I am looking at coding as: 44145 44139 44140/59 vs. 44160/59 44310 Will you please let me know what you think? the documentation is not very clear when it comes to...
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    HELP! Pacer and ICD Denials

    Yes, I am getting denials for 33249 and 33225 when billed with ICD-9 codes: 428.0, 426.3, 414.8, 414.01. Are these codes even covered for these procedures? I have to meet with this provider on Monday or Tuesday to go over this information and really need to get some solid documentation...
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    HELP! Pacer and ICD Denials

    I am working on medical necessity denials for pacemaker and ICD insertions. I used to code these all the time but haven't since 2009 and at that time there were very specific guidelines and diagnosis codes that Medicare would cover. Now, Medicare just keeps telling the billers to look at the...
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    Depo Provera

    Does anyone know what the correct DX is for reporting the depo injection? V25.09? V25.9? V25.49? I can't seem to find anything that is definitive.
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    Yervoy billing - J9228

    Hello. I am trying to figure out hot to bill for Yervoy (J9228) and was wondering if any one else has billed this drug. It comes in a 200mg single dose vial and the patient received 169mg. Should we bill this drug as 169 units or is it just 1 unit for the entire SDV? Thanks in advance for...
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    Lead Replacement

    Thank you SO much for your reply! I looked at the codes and I agree with using 33235 and 33216. Where did you find the instructions to use the dual lead system even if one lead is replaced? I can see how that would be very confusing....Thanks again!
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    Lead Replacement

    That would be fantastic! I will send you my fax and email in a private message. I really do appreciate your help!
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    Lead Replacement

    Hello! I used to dabble in Cardiology coding but am not up to par and really need some help with all of these new CPT codes. I am trying to code a pacemaker lead replacement but am not sure which way to go. Here is a copy of the op note: Following oral and written informed consent, the...
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    To use 22 or not to use 22, that's the ??

    I have a provider who wants to add a 22 modifier to their procedure but I don't think that the documentation supports a 22 modifier. There is nothing in the body of the op note to indicate that the procedure was more difficult or took extra time. The only part that states anything about the...
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    Neurostimulator analysis

    I am looking at charges for an implanted neurostimulator analysis and the physician billed codes: 95978 (for the first hour), 95979 (each addt'l 30 min.), and 95979 (for an addt'l 30 min.) all on the same DOS. The claim had each code on it's own line item and one of the 95979's was denied as...
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    Q2049 - Lipodox

    Hello. Are any of you billing for the drug Lipodox because of the national shortage of Doxil? If so, does anyone know what Medicare's pricing is or how much they pay for Lipodox? I've gotten conflicting answers when I asked for the price and the dose of the drug. I know that it comes in two...
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    Place of service 22 vs. 11

    Hello. I wasn't sure where to post this question so I'm posting in two places in hopes that someone can help me out. We have an oncology center that has physician offices (place of service 11)on one side of the building and then the patients get their infusion done across the hall in the...
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    Modifier 25 day of chemo

    Yes, we charge for E/M services on the same day as chemo. Just add modifier 25 and you should be fine.
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    E/M visit on same day as infusion service

    Hello. I wasn't sure where to post this question so I'm posting in two places in hopes that someone can help me out. We have an oncology center that has physician offices (place of service 11) and then the patients get their infusion done across the hall in the outpatient infusion center...
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    DOS for EEG Interpretation

    If a physician reads an EEG that was done on a inpatient, but he does the read on a different DOS than when the test was performed, what DOS should he use for his interpretation? I'm getting conflicting information and could use some clarification. Does anyone know if Medicare has guidelines...
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    Can a chiropractor bill E/M codes to Medicare

    I am searching for some documentation from Medicare about E/M visits and chiropractors. Does anyone know if chiropractors can bill Medicare for E/M visits and if so, is there a policy or documentation on this somewhere? Thanks in advance for your help! :confused:
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    HCPCS Code S9472 and Reimbursement

    Hello! I am doing some research on the Temporary HCPCS code, S9472 and was wondering if anyone has any experience billing this code and what your experience was like, who paid, who doesn't pay, how did you figure out how much to charge for it, etc. Any information would be greatly appreciated! :D
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    Procedures similar to TAVR (0256T)

    We have a new provider who is going to be performing the TAVR procedure and we are trying to find procedures that are similiar to the category III CPT codes 0256T and 0257T. If anyone can help lead me in the right direction in order to find CPT codes that are somewhat similar to these...
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    Arterial Catheterization with AVR

    Does anyone know if it is ok to code the arterial catheterization for monitoring (36620) along with an aortic valve repair (33405) and CABG (33533)? I am thinking that it is included in the primary procedures but cannot locate anything to confirm this. I am having a hard time reading the op...
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    Sternotomy CPT Code?

    Julie - Thanks! I think that is probably the best code, I appreciate your help!
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    Sternotomy CPT Code?

    There is no dx, I am doing a comparison between Category III T-Codes (0258T) and current Cardiac CPT codes. I am looking for a CPT code that is similar to 0258T (Transthoracic cardiac exposer (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without...
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    Pap/HPV interpretation

    If our GYN doc bills out an 88175 for the thin prep part of the path and the laboratory does not bill the patient, they bill our facility directly, is it appropriate to also bill 88141 & 87621 if the GYN doc then interprets the pap and decided to test for HPV? :confused:
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    Sternotomy CPT Code?

    Does anyone know if there is a CPT code for just a sternotomy? :confused:
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    codes 96401 & 96402

    I use 96402 when giving Faslodex, Zoladex or Lupron. These are all hormonal anti-neoplastic drugs; I do not use 96401 very often.
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    oral meds in clinic

    Do you have any documentation that states that this is the correct way to bill for Xeloda? We give this drug often but do not bill for it because it is an oral drug. Thanks for your help!
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    Surgical Documentation Guidelines - group of Oncologists

    I know what needs to be included, I was just wondering if there are any guidelines or documentation from a trusted source (CMS, Medicare, etc.) about how to document a procdure note. A bone marrow bx is a surgical procedure because it is invasive. No, it is not as extensive as a mastectomy or...
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    PDX for Neulasta

    Sometimes Neulasta is used as part of certain treatment regimens and you can use the prophylactic use code V07.8 (per the Medicare LCD) but you definitely need to find out if the patient is receiving the drug because of neutropenia or prophylactically.
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    Surgical Documentation Guidelines - group of Oncologists

    I am trying to teach a group of Oncologists how to document op reports when they do bone marrow biopsies. Does anyone know where I can find any guidelines on how to document an op report? I come from a general surgery background but most surgeons know how to document what they did...
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